Healthcare Provider Details

I. General information

NPI: 1043234016
Provider Name (Legal Business Name): CAROLE M. HANNERS R.D.,M.S., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR LD120
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

500 FIELD CREST CT
RICHMOND KY
40475-7536
US

V. Phone/Fax

Practice location:
  • Phone: 859-281-3825
  • Fax: 859-281-3864
Mailing address:
  • Phone: 859-281-3825
  • Fax: 859-281-3864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: